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Shahbandi A, Jahangiri P, Meybodi KT, Nejat F, Habibi Z. Implementation of an adapted perioperative ventriculoperitoneal shunting protocol in a tertiary center located in a low-to-middle-income country. Childs Nerv Syst 2024; 40:1839-1847. [PMID: 38557895 DOI: 10.1007/s00381-024-06374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Preventative protocols have efficaciously reduced shunt infection in developed countries. However, the generalizability of these protocols in low-to-middle-income countries (LMICs) remains unclear. Previously, shunt insertion in the authors' center was routinely performed under institutional preventative precautions, which was updated via merging with the Hydrocephalus Clinical Research Network (HCRN) protocol. This study aimed to investigate the ventriculoperitoneal shunt (VPS) infection rates in pediatric patients following the implementation of the adapted protocol. METHODS The adapted protocol was implemented in all first-time VPS implantations between 2011 and 2021. The primary outcome was a 6-month shunt infection. The Pearson chi-square test was used for categorical variables and the Mann-Whitney U-test for numeric variables to evaluate the correlation with shunt infection. RESULTS A total of 352 first-time VPS procedures were performed adhering to the adapted protocol. The median age was 5 months, and 189 (53.7%) were male. Overall, 37 patients (10.5%) experienced shunt infection, with 30 (8.5%) occurring within the first 6 months, which was lower than 13.3% infection rate of the previous series of the same center. The infection rate was slightly higher than the 5.7% and 6.0% rates reported by HCRN studies. Patients with shunt infection were significantly younger (7.5 versus 17.5 months, P < 0.001). CONCLUSIONS This study validates the efficacy of an adapted perioperative protocol in mitigating shunt infection in a high-volume center in a LMIC. Adhering to a step-by-step protocol, modified to suit the healthcare resources and financial constraints of LMICs, could maintain low shunt infection rates that are roughly comparable to those of centers in high-income countries.
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Affiliation(s)
- Ataollah Shahbandi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Jahangiri
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Tayebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Podkovik S, Zhou C, Coffin SE, Hall M, Hauptman JS, Kronman MP, Mangano FT, Pollack IF, Sedano S, Vega J, Schaffzin JK, Thorell E, Warf BC, Whitlock KB, Simon TD. Antibiotic impregnated catheters and intrathecal antibiotics for CSF shunt infection prevention in children undergoing low-risk CSF shunt surgery. BMC Pediatr 2024; 24:325. [PMID: 38734598 PMCID: PMC11088062 DOI: 10.1186/s12887-024-04798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) shunts allow children with hydrocephalus to survive and avoid brain injury (J Neurosurg 107:345-57, 2007; Childs Nerv Syst 12:192-9, 1996). The Hydrocephalus Clinical Research Network implemented non-randomized quality improvement protocols that were shown to decrease infection rates compared to pre-operative prophylactic intravenous antibiotics alone (standard care): initially with intrathecal (IT) antibiotics between 2007-2009 (J Neurosurg Pediatr 8:22-9, 2011), followed by antibiotic impregnated catheters (AIC) in 2012-2013 (J Neurosurg Pediatr 17:391-6, 2016). No large scale studies have compared infection prevention between the techniques in children. Our objectives were to compare the risk of infection following the use of IT antibiotics, AIC, and standard care during low-risk CSF shunt surgery (i.e., initial CSF shunt placement and revisions) in children. METHODS A retrospective observational cohort study at 6 tertiary care children's hospitals was conducted using Pediatric Health Information System + (PHIS +) data augmented with manual chart review. The study population included children ≤ 18 years who underwent initial shunt placement between 01/2007 and 12/2012. Infection and subsequent CSF shunt surgery data were collected through 12/2015. Propensity score adjustment for regression analysis was developed based on site, procedure type, and year; surgeon was treated as a random effect. RESULTS A total of 1723 children underwent initial shunt placement between 2007-2012, with 1371 subsequent shunt revisions and 138 shunt infections. Propensity adjusted regression demonstrated no statistically significant difference in odds of shunt infection between IT antibiotics (OR 1.22, 95% CI 0.82-1.81, p = 0.3) and AICs (OR 0.91, 95% CI 0.56-1.49, p = 0.7) compared to standard care. CONCLUSION In a large, observational multicenter cohort, IT antibiotics and AICs do not confer a statistically significant risk reduction compared to standard care for pediatric patients undergoing low-risk (i.e., initial or revision) shunt surgeries.
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Affiliation(s)
- Stacey Podkovik
- Department of Neurological Surgery, Riverside University Health Sciences Medical Center, Riverside, CA, USA
| | - Chuan Zhou
- Center for Child Health, Seattle Children's Research Institute, Behavior, and Development, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Susan E Coffin
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthew Hall
- Children's Hospital Association, Lenexa, KS, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew P Kronman
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Francesco T Mangano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sabrina Sedano
- Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd,, MS 94, Los Angeles, CA, 90027, USA
| | - Joaquin Vega
- Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd,, MS 94, Los Angeles, CA, 90027, USA
| | | | - Emily Thorell
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Harvard School of Medicine, Boston, MA, USA
| | | | - Tamara D Simon
- Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd,, MS 94, Los Angeles, CA, 90027, USA.
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Ammar AS, Elnoamany H, Elkholy H. Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce Postoperative Shunt Infection Rate? J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38336112 DOI: 10.1055/a-2265-9325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery. METHODS We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022. RESULTS Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (p = 0.010), patients with a previous shunt revision (p < 0.001), and those with a previous shunt infection (p < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (p = 0.023). CONCLUSIONS Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries.
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Affiliation(s)
- Ahmed Shawky Ammar
- Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Hossam Elnoamany
- Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Hany Elkholy
- Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
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Podkovik S, Zhou C, Coffin SE, Hall M, Hauptman JS, Kronman MP, Mangano FT, Pollack IF, Sedano S, Schaffzin JK, Thorell E, Warf BC, Whitlock KB, Simon TD. Utilization trends in cerebrospinal fluid shunt infection prevention techniques in the United States from 2007 to 2015. J Neurosurg Pediatr 2024; 33:349-358. [PMID: 38181501 PMCID: PMC10810681 DOI: 10.3171/2023.11.peds2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 11/03/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The objective of this study was to describe trends in the utilization of infection prevention techniques (standard care, intrathecal [IT] antibiotics, antibiotic-impregnated catheters [AICs], and combination of IT antibiotics and AICs) among participating hospitals over time. METHODS This retrospective cohort study at six large children's hospitals between 2007 and 2015 included children ≤ 18 years of age who underwent initial shunt placement between 2007 and 2012. Pediatric Health Information System + (PHIS+) data were augmented with chart review data for all shunt surgeries that occurred prior to the first shunt infection. The Pearson chi-square test was used to test for differences in outcomes. RESULTS In total, 1723 eligible children had initial shunt placement between 2007 and 2012, with 3094 shunt surgeries through 2015. Differences were noted between hospitals in gestational age, etiology of hydrocephalus, and race and ethnicity, but not sex, weight at surgery, and previous surgeries. Utilization of infection prevention techniques varied across participating hospitals. Hydrocephalus Clinical Research Network hospitals used more IT antibiotics in 2007-2011; after 2012, increasing adoption of AICs was observed in most hospitals. CONCLUSIONS A consistent trend of decreasing IT antibiotic use and increased AIC utilization was observed after 2012, except for hospital B, which consistently used AICs.
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Affiliation(s)
- Stacey Podkovik
- Department of Neurological Surgery, Riverside University Health Sciences Medical Center, Riverside, California
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Susan E. Coffin
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | | | - Matthew P. Kronman
- Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Ian F. Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sabrina Sedano
- Department of Hospital Medicine, Children’s Hospital Los Angeles, California
| | | | - Emily Thorell
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Benjamin C. Warf
- Department of Neurosurgery, Harvard School of Medicine, Boston, Massachusetts; and
| | - Kathryn B. Whitlock
- Department of Hospital Medicine, Children’s Hospital Los Angeles, California
| | - Tamara D. Simon
- Department of Hospital Medicine, Children’s Hospital Los Angeles, California
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
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Elbaroody M, Ezz A, Eldessouky AH, Hassan AAAN, Elsharkawy AA, Ali KB, Refaee EAE. Is It Possible to Eliminate Postoperative Shunt Infections?: Results of a Modified Hydrocephalus Clinical Research Network Protocol. J Neurol Surg A Cent Eur Neurosurg 2024; 85:32-38. [PMID: 36693411 DOI: 10.1055/s-0042-1760227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Postoperative shunt infection is a nightmare in neurosurgical practice with additional morbidity and mortality. A lot of protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections but not eradication. The aim of the study was to evaluate the rigid application of a modified Hydrocephalus Clinical Research Network (HCRN) protocol in the prevention of postoperative shunt infection. METHODS We retrospectively evaluated children with congenital hydrocephalus who underwent VPS insertion, and in whom the protocol was applied from June 2019 to January 2020. Follow-up ranged from 11 to 24 months. RESULTS Thirty-seven procedures were performed including 35 primary shunt insertions and two revision surgeries. The median age was 5 months (range, 1-30 months), and 25 patients were males. The most common cause for VPS placement was congenital hydrocephalus without identifiable cause in 28 cases (80%). The endoscope-assisted technique was used in the insertion of the proximal end in six cases (17%). The mean follow-up was 19.4 months (11-24 months). The rate of shunt infection was 0% till the last follow-up. CONCLUSION The preliminary results showed an effective method for the prevention of postoperative shunt infections using the modified protocol. These initial findings need to be validated in a large prospective study before widespread application can be recommended.
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Affiliation(s)
- Mohammad Elbaroody
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Adham Ezz
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Amr Helmy Eldessouky
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed A Aziz N Hassan
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed Abbas Elsharkawy
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Khaled Bassim Ali
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ehab Ahmed El Refaee
- Department of Neurosurgery, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt
- Department of Neurosurgery, Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie. Sauerbruchstraße, Greifswald, Germany
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Khalid SI, Deysher D, Khilwani H, Mirpuri P, Thomson K, Maynard M, Mehta AI. Gastrostomy Sequence With Ventriculoperitoneal Shunting-Does It Matter? Neurosurgery 2023; 93:1154-1159. [PMID: 37283524 DOI: 10.1227/neu.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/12/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Neurological injury requiring ventriculoperitoneal shunt (VPS) placement often necessitates gastrostomy for nutritional support. The sequence of these procedures is debated over concerns for shunt infection and displacement requiring revisional surgery as a consequence of gastrostomy. OBJECTIVE To determine the optimal sequence of VPS shunt and gastrostomy tube placement in adults. METHODS In an all-payer database, adult patients undergoing gastrostomy and VPS placement were identified within 15 days between January 2010 and October 2021. Patients were categorized as receiving gastrostomy before, on the same day as, or after shunt placement. The primary outcomes of this study were rates of revision and infection. All outcomes were evaluated within 30 months after index shunting. RESULTS In total, 3015 patients were identified as undergoing VPS and gastrostomy procedures within 15 days. After a 1:1:1 match, 1080 patient records were analyzed. Revision rates at 30 months were significantly lower among patients who received VPS and gastrostomy procedures on the same day compared with gastrostomy after VPS (odds ratio [OR] 0.61, 95% CI 0.39-0.96). In addition, patients who received gastrostomy before VPS compared with those after had lower revision rates (OR 0.61, 95% CI 0.39-0.96) and infection (OR 0.46, 95% CI 0.21-0.99). No significant differences were noted in mechanical complication or shunt displacement rates. CONCLUSION Patients requiring VPS and gastrostomy may benefit from undergoing both procedures concurrently or with gastrostomy before VPS placement, secondary to lower revision rates. Patients undergoing gastrostomy before VPS have the added benefit of decreased infection rates.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Harsh Khilwani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago , Illinois , USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago , Illinois , USA
| | - Marquis Maynard
- Case Western Reserve School of Medicine, Cleveland , Ohio , USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
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Hect JL, Sefcik RK, Nowicki KW, Katz J, Greene S. Serial Neuroendoscopic Lavage for the Treatment of Elevated Cerebrospinal Fluid Protein Levels in Infants with Gram-Negative Rod Ventriculitis. Pediatr Neurosurg 2023; 58:401-409. [PMID: 37703859 DOI: 10.1159/000534083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Gram-negative rod (GNR) bacterial ventriculitis is a rare complication of shunt-dependent hydrocephalus, often requiring an extended and invasive treatment course. Accumulation of purulent material, as well as empyema and septation formation, limits circulation of antibiotics and infection clearance. Supplementation of standard care with neuroendoscopic-guided intraventricular lavage with lactated Ringer solution and fenestration of septations may facilitate infection clearance and simplify the eventual shunt construct required. Here, the utility of serial lavage for ventriculitis is described in a population of shunt-dependent neonates and infants at high risk for morbidity and mortality. METHODS Five infants with shunt-dependent hydrocephalus and subsequent GNR ventriculitis were treated with standard care measures with the addition of serial neuroendoscopic lavage. A retrospective chart review was performed to collect patient characteristics, shunt dependency, and shunt revisions within a year of ventriculitis resolution. RESULTS Patients demonstrated a mean 74% decrease in cerebrospinal fluid (CSF) protein following each neuroendoscopic lavage and trended toward a shorter time to infection clearance in comparison to previously published literature. Patients required 0-2 shunt revisions at 1-year follow-up following hospitalization for shunt-related ventriculitis (mean 0.8 +/- 0.8). CONCLUSIONS Serial neuroendoscopic lavage is an effective technique, used alone or in combination with fenestration of septations, to reduce the CSF protein and bacterial load in the treatment of ventriculitis, decreasing time until eradication of infection. Serial lavage may reduce the risk of future shunt malfunction, simplify the future shunt construct, and decrease duration of infection.
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Affiliation(s)
- Jasmine L Hect
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Roberta K Sefcik
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kamil W Nowicki
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joel Katz
- Department of Pediatric Neurosurgery, Akron Children's Hospital, Akron, Ohio, USA
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Konrad E, Robinson JL, Hawkes MT. Cerebrospinal fluid shunt infections in children. Arch Dis Child 2023; 108:693-697. [PMID: 36450441 DOI: 10.1136/archdischild-2022-324559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
Cerebrospinal fluid (CSF) shunts are commonly used for the long-term management of hydrocephalus in children. Shunt infection remains a common complication, occurring in about 5%-15% of CSF shunts. This narrative review summarises key evidence from recent literature on the epidemiology, pathogenesis, clinical presentation, diagnosis, management, outcomes and prevention of CSF shunt infections in children. The majority of shunt infections occur due to contamination at the time of surgery, with coagulase-negative staphylococci and Staphylococcus aureus being the most common infecting organisms. Clinical presentations of shunt infection can be varied and difficult to recognise. CSF cultures are the primary test used for diagnosis. Other CSF and blood parameters may aid in diagnosis but lack sensitivity and specificity. Core aspects of management of shunt infections include systemic antimicrobial therapy and surgical removal of the shunt. However, many specific treatment recommendations are limited by a lack of robust evidence from large studies or controlled trials. Shunt infections may result in long hospital stays, worsening hydrocephalus, neurological sequelae and other complications, as well as death. Therefore, reducing the incidence of infection and optimising management are high priorities. Antibiotic prophylaxis at the time of shunt placement, improved surgical protocols and antibiotic-impregnated shunts are key strategies to prevent shunt infections. Nevertheless, further work is needed to identify additional strategies to prevent complications and improve outcomes.
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Affiliation(s)
- Emily Konrad
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Greuter L, Ruf L, Guzman R, Soleman J. Open versus laparoscopic ventriculoperitoneal shunt placement in children: a systematic review and meta-analysis. Childs Nerv Syst 2023; 39:1895-1902. [PMID: 37225936 PMCID: PMC10290606 DOI: 10.1007/s00381-023-05966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ventriculoperitoneal shunt (VPS) surgery is the traditional method for treating hydrocephalus, remaining one of the most regularly used procedures in pediatric neurosurgery. The reported revision rate of VPS can reach up to 80% and significantly reduces the quality of life in the affected children and has a high socioeconomic burden. Traditionally, distal VPS placement has been achieved open via a small laparotomy. However, in adults several studies have shown a lower rate of distal dysfunction using laparoscopic insertion. As the data in children are scarce, the aim of this systematic review and meta-analysis was to compare open and laparoscopic VPS placement in children regarding complications. METHODS PubMed and Embase databases were searched using a systematic search strategy to identify studies comparing open and laparoscopic VPS placement up to July 2022. Two independent researchers assessed the studies for inclusion and quality. Primary outcome measure was distal revision rate. A fixed effects model was used if low heterogeneity (I2 < 50%) was present, otherwise a random effects model was applied. RESULTS Out of 115 screened studies we included 8 studies in our qualitative assessment and three of them in our quantitative meta-analysis. All studies were retrospective cohort studies with 590 analyzed children, of which 231 children (39.2%) received laparoscopic, and 359 children (60.8%) open shunt placement. Similar distal revision rates were observed between the laparoscopic and open group (3.75% vs. 4.3%, RR 1.16, [ 95% CI 0.48 to 2.79], I2 = 50%, z = 0.32, p = 0.74). There was no significant difference in postoperative infection rate between the two groups (laparoscopic 5.6% vs. open 7.5%, RR 0.99, (95% CI [0.53 to 1.85]), I2=0%, z = -0.03, p= 0.97). The meta-analysis showed a significantly shorter surgery time in the laparoscopic group (49.22 (±21.46) vs. 64.13 (±8.99) minutes, SMD-3.6, [95% CI -6.9 to -0.28], I2=99%m z= -2.12, p= 0.03) compared to open distal VPS placement. CONCLUSION Few studies are available comparing open and laparoscopic shunt placement in children. Our meta-analysis showed no difference in distal revision rate between laparoscopic and open shunt insertion; however, laparoscopic placement was associated with a significantly shorter surgery time. Further prospective trials are needed to assess possible superiority of one of the techniques.
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Affiliation(s)
- Ladina Greuter
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Linus Ruf
- Department of Pediatric Neurosurgery, University Children Hospital of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Pediatric Neurosurgery, University Children Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Pediatric Neurosurgery, University Children Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Fisher WAM, Catalino MP, Woolard EA, Andrews BJ, Elton S, Quinsey C. Surgical instruments and catheter damage during ventriculoperitoneal shunt assembly. J Neurosurg 2023; 138:1740-1747. [PMID: 36242572 DOI: 10.3171/2022.8.jns22746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current surgical techniques use common surgical instruments for sterile shunt assembly. This study investigated the impact of using these techniques and surgical instruments on the mechanical integrity of the ventriculoperitoneal shunt system, specifically shunt catheters. METHODS The authors conducted failure testing on 85 rifampin-coated catheters and 85 barium-impregnated catheters using 5 different surgical instruments and 2 different surgical techniques. In technique A, the distal end of the catheter was pushed onto the shunt valve inlet connector with the surgical instrument. In technique B, the catheter was pulled over the inlet connector. One hundred sixty catheters underwent 10-repetition-maximum testing, in which the catheter either failed before completion of 10 consecutive assembly/disassembly repetitions or the catheter completed 10 consecutive repetitions. The authors also conducted 100-repetition-maximum tests on 5 barium-impregnated and 5 rifampin-coated catheters using technique A. RESULTS Catheter failure rates were significantly different among the different instruments used in assembly (p ≤ 0.001). Post hoc analysis showed that using mosquito forceps with shods resulted in a significantly lower catheter failure rate than the other instruments (p < 0.0005). The catheter failure rate of technique A was significantly lower than that of technique B (5% vs 81%, p < 0.001). There was no statistical difference between the failure rates of the barium and rifampin catheters (42% vs 44%, p = 0.9), but the barium catheters outperformed the rifampin catheters in the 100-repetition-maximum trials (p = 0.02). Instrument type (p = 0.0232) and catheter type (p = 0.0096) were both significant factors in determining the number of assembly/disassembly repetitions needed to cause catheter failure. It took an average of 2.79 repetitions of assembly/disassembly to cause catheter failure. DeBakey forceps had significantly lower mean repetitions to failure (mean 1.38) than the Gerald forceps without teeth (mean 2.73, p = 0.05) and bayonet (mean 3.25, p = 0.02). CONCLUSIONS This study was the first of its kind to analyze how physical manipulation affects the mechanical integrity of ventriculoperitoneal shunt components. The authors demonstrated a significantly lower shunt catheter failure rate when mosquito forceps with shods and technique A were used in assembly. Moreover, the authors established that use of DeBakey forceps resulted in failure with fewer assembly/disassembly repetitions than use of the Gerald and bayonet forceps, suggesting that DeBakey forceps are the most damaging instrument.
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Device and surgical procedure-related infections in Canadian acute care hospitals, 2017-2021. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:221-234. [PMID: 38419908 PMCID: PMC10901258 DOI: 10.14745/ccdr.v49i05a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2017 to 2021. Methods Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Results Between 2017 and 2021, 2,898 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units representing 69% (n=2,002) of all reported infections under surveillance. Significant rate increases were observed in adult mixed intensive care unit CLABSIs (1.08-2.11 infections per 1,000 line days, p=0.014) while decreases were observed in SSIs following knee arthroplasty (0.34-0.27 infections per 100 surgeries, p=0.05). No changes in trends were observed in the other reported HAIs. Of the 3,089 pathogens identified, the majority were gram-positive (66%), followed by gram negative (23%) and fungi (11%). Coagulase-negative staphylococci (22%) and Staphylococcus aureus (17%) were the most frequently isolated pathogens. Conclusion Epidemiological and microbiological trends among select device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.
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Wang HQ, Han P, Huang QB, Zhang ZL. Clinical Characteristics and Treatment of Early and Delayed Intra-Ccranial Infection After Ventriculoperitoneal Shunt in Adults: Retrospective Analysis of Nineteen Cases. Surg Infect (Larchmt) 2023; 24:66-74. [PMID: 36580653 DOI: 10.1089/sur.2022.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives: Intra-cranial infection is the most serious complication after ventriculoperitoneal shunt (VPS). There were differences in clinical characteristics between early (occurs within one month after VPS, the early group) and delayed (occurs 1 month or more after VPS, the delayed group) infections. The aim of this study is to clarify the differences between the two groups. Patients and Methods: All cases diagnosed as intracranial infection after VPS between September 2017 and December 2021 were collected. Clinical data were reviewed and analyzed retrospectively. Results: Nineteen cases met the inclusion criteria, including 12 cases in the early group and seven cases in the delayed group. There were no significant differences between the two groups in gender, age, and etiology of hydrocephalus. Cases in the early group usually had fever with worsening consciousness (11; 91.7%), which was caused by surgical operations (10; 83.3%) with gram-positive coccis infection (9; 75.0%), whereas those in the delayed group had abdominal pain (5; 71.4%), caused by abdominal factor (7; 100%) with gram-negative bacilli infection (6; 85.7%). There were differences in symptoms (p < 0.01), causes of infection (p < 0.001), and pathogens (p < 0.05). Shunt removal was performed for all 19 cases. After the infection was controlled, eight cases received VPS again, and no re-infection occurred after a follow-up of four to 22 months. Conclusions: It is suggested in this study that there were differences between the two groups in terms of etiology, symptoms, and pathogens. The results can provide theoretical basis for prevention, early diagnosis, and reasonable treatment of infection after VPS.
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Affiliation(s)
- Hua-Qing Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China
| | - Ping Han
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China.,Nursing Theory and Practice Innovation Research Center of Shandong University, Shandong, P.R. China
| | - Qi-Bing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China
| | - Ze-Li Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China
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13
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Zhang H, He X, Xie L, Zhang H, Hou X, Zhang S. Correlation between cerebrospinal fluid abnormalities before ventriculoperitoneal shunt and postoperative intracranial infection in adult patients with hydrocephalus: A clinical study. Front Neurol 2023; 13:1023761. [PMID: 36761915 PMCID: PMC9902906 DOI: 10.3389/fneur.2022.1023761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/31/2022] [Indexed: 01/25/2023] Open
Abstract
Objective To identify the relationship between preoperative cerebrospinal fluid (CSF) leukocyte, chloride, glucose, aspartate aminotransferase, lactate dehydrogenase, adenosine deaminase, lactic acid and protein levels and ventriculoperitoneal shunt infection. Methods Records of 671 consecutive adult patients who underwent ventriculoperitoneal shunt surgery for the treatment of hydrocephalus at Zhujiang Hospital affiliated with Southern Medical University from January 2011 to March 2022 were reviewed. The patients were divided into infection and non-infection groups based on the presence of postoperative infection. For all patients, we analyzed age; sex; primary disease; preoperative CSF leukocyte, chloride, glucose, aspartate aminotransferase, lactate dehydrogenase, adenosine deaminase, lactic acid and protein levels; postoperative temperature; and postoperative infection. Results A total of 397 patients were included, 28 (7.05%) of whom had an infection within 6 months of the operation and the remaining had no infection. There was no significant difference in age, sex, primary disease, leukocyte, chloride ion, aspartate aminotransferase, lactate dehydrogenase, adenosine deaminase and protein levels in CSF between infection group and non-infection group (p > 0.05). The postoperative infection rate of patients with CSF glucose < 2.8 mmol/L (x 2 = 11.650, p = 0.001) and CSF lactic acid >2.8 mmol/L (x 2 = 12.455, p < 0.001) was higher than that of patients with CSF glucose level ≥2.8 mmol/L and CSF lactic acid level in the range of (1-2.8) mmol/L, respectively, with statistical difference. Compared with the non-infection group, the level of CSF glucose (t = 4.113, p < 0.001) was significantly lower, and the level of CSF lactic acid (t = 6.651, p < 0.001) was significantly higher in the infection group. Multivariate logistic regression analysis showed that preoperative cerebrospinal fluid glucose < 2.8 mmol/L (OR = 3.911, 95% CI: 1.653~9.253, p = 0.002) and cerebrospinal fluid lactate >2.8 mmol/L (OR = 4.712, 95% CI: 1.892~11.734, p = 0.001) are risk factors for infection after ventriculoperitoneal shunt. ROC analysis revealed that the area under the curve (AUC) for CSF glucose and lactic acid level were 0.602 (95% CI: 0.492-0.713) and 0.818 (95% CI: 0.738-0.898), respectively. The infection group had higher rates of fever and body temperature on postoperative day 3-7 (p < 0.05). Conclusions For adult hydrocephalus patients without clinical manifestations of intracranial infection but only with simple abnormality of cerebrospinal fluid, when the content of glucose in cerebrospinal fluid is < 2.8 mmol/L, and the content of lactic acid is >2.8 mmol/L, it is recommended to perform ventriculoperitoneal shunt after further improvement of cerebrospinal fluid indicators, otherwise, hasty operation will increase the postoperative infection rate. The postoperative fever rate of ventriculoperitoneal shunt surgery is high and the body temperature drops rapidly. If there is still fever after day 3 after surgery, whether there is intracranial infection should be considered.
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Affiliation(s)
- Huan Zhang
- Department of Neurosurgery, Affiliated Hospital No. 2 of Nantong University, First People's Hospital of Nantong City, Nantong, China
| | - Xiaozheng He
- Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Linghai Xie
- Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Hongbo Zhang
- Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xusheng Hou
- Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Shizhong Zhang
- Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China,*Correspondence: Shizhong Zhang ✉
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14
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Xu L, Zhu J, Wang X, Zeng G, Gao Z, Liu J. Clinical features and risk factors of surgical site infections in HIV-negative patients with cryptococcal meningitis underwent ventriculoperitoneal shunt operations: a retrospective study. BMC Infect Dis 2022; 22:736. [PMID: 36104794 PMCID: PMC9476323 DOI: 10.1186/s12879-022-07719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background To investigate the clinical features and risk factors of ventriculoperitoneal shunt (VPS) associated surgical site infections (SSIs) in HIV-negative patients with cryptococcal meningitis (CM). Methods We retrospectively reviewed the medical records of HIV-negative patients with CM underwent VPS operation admitted to The Third Affiliated Hospital of Sun Yat-sen University in Southwest China over the past 7 years. Results 193 patients were included, of whom 25 (12.95%) had SSIs in 6 (median duration, 1–48 days) days after operation. Compared with patients without SSIs, patient with SSIs tended to be shorter preoperative stay. 52% patients in SSIs group and 25% patients in no-SSIs group underwent VPS operations within 3 days after admission (p = 0.017). Although body temperature and infectious indicators slightly elevated postoperative in both groups. The patients with SSIs experienced more fever; more central nervous system symptoms; higher PCT value and lower cerebrospinal fluid (CSF) glucose in contrast to the no-SSIs group. Multivariate regression analysis found a 2.653 fold increase in the risk of infection for every 1 °C increase in postoperative body temperature. Among the 25 patients, 9 patients had positive culture results, three samples reported to be oxacillin resistant coagulase-negative Staphylococci. Conclusions SSIs was one of the serious surgical complications after VPS operation. High body temperature, the occurrence of dizziness and headache, low postoperative hemoglobin are risk factors. Postoperative patients with high fever, high PCT and low CSF glucose should be paid more attention to.
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Pindrik J, Schulz L, Drapeau A. Diagnosis and Surgical Management of Neonatal Hydrocephalus. Semin Pediatr Neurol 2022; 42:100969. [PMID: 35868728 DOI: 10.1016/j.spen.2022.100969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Neonatal hydrocephalus represents an important pathological condition with significant impact on medical care and neurocognitive development. This condition requires early recognition, appropriate medical and surgical management, and long-term surveillance by clinicians and pediatric neurosurgeons. Common etiologies of neonatal and infant hydrocephalus include intraventricular hemorrhage related to prematurity with subsequent post-hemorrhagic hydrocephalus, myelomeningocele, and obstructive hydrocephalus due to aqueductal stenosis. Clinical markers of elevated intracranial pressure include rapid increases in head circumference across percentiles, elevation and firmness of the anterior fontanelle, splitting or splaying of cranial sutures, upgaze palsy, lethargy, frequent emesis, or episodic bradycardia (unrelated to other comorbidities). Complementing these clinical markers, imaging modalities used for the diagnosis of neonatal hydrocephalus include head ultrasonography, brain magnetic resonance imaging, and head computed tomography in urgent or emergent situations. Following diagnosis, temporizing measures may be employed prior to definitive treatment and include ventricular access device or ventriculo-subgaleal shunt insertion. Definitive surgical management involves permanent cerebrospinal fluid (CSF) diversion via CSF shunt insertion, or endoscopic third ventriculostomy with or without choroid plexus cauterization. Surgical decision-making and approaches vary based on patient age, hydrocephalus etiology, neuroanatomy, imaging findings, and medical comorbidities. Indications, surgical techniques, and clinical outcomes of these procedures continue to evolve and elicit significant attention in the research environment. In this review we describe the epidemiology, pathophysiology, clinical markers, imaging findings, early management, definitive surgical management, and clinical outcomes of pediatric patients with neonatal hydrocephalus.
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Affiliation(s)
- Jonathan Pindrik
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH; Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH.
| | - Lauren Schulz
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Annie Drapeau
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH; Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH
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16
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Chu J, Jensen H, Holubkov R, Krieger MD, Kulkarni AV, Riva-Cambrin J, Rozzelle CJ, Limbrick DD, Wellons JC, Browd SR, Whitehead WE, Pollack IF, Simon TD, Tamber MS, Hauptman JS, Pindrik J, Naftel RP, McDonald PJ, Hankinson TC, Jackson EM, Rocque BG, Reeder R, Drake JM, Kestle JRW. The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation. J Neurosurg Pediatr 2022:1-8. [PMID: 35303708 DOI: 10.3171/2022.2.peds2214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Two previous Hydrocephalus Clinical Research Network (HCRN) studies have demonstrated that compliance with a standardized CSF shunt infection protocol reduces shunt infections. In this third iteration, a simplified protocol consisting of 5 steps was implemented. This analysis provides an updated evaluation of protocol compliance and evaluates modifiable shunt infection risk factors. METHODS The new simplified protocol was implemented at HCRN centers on November 1, 2016, for all shunt procedures, excluding external ventricular drains, ventricular reservoirs, and subgaleal shunts. Procedures performed through December 31, 2019, were included (38 months). Compliance with the protocol, use of antibiotic-impregnated catheters (AICs), and other variables of interest were collected at the index operation. Outcome events for a minimum of 6 months postoperatively were recorded. The definition of infection was unchanged from the authors' previous report. RESULTS A total of 4913 procedures were performed at 13 HCRN centers. The overall infection rate was 5.1%. Surgeons were compliant with all 5 steps of the protocol in 79.4% of procedures. The infection rate for the protocol alone was 8.1% and dropped to 4.9% when AICs were added. Multivariate analysis identified having ≥ 2 complex chronic conditions (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.26-2.44, p = 0.01) and a history of prior shunt surgery within 12 weeks (OR 1.84, 95% CI 1.37-2.47, p < 0.01) as independent risk factors for shunt infection. The use of AICs (OR 0.70, 95% CI 0.50-0.97, p = 0.05) and vancomycin irrigation (OR 0.36, 95% CI 0.21-0.62, p < 0.01) were identified as independent factors protective against shunt infection. CONCLUSIONS The authors report the third iteration of their quality improvement protocol to reduce the risk of shunt infection. Compliance with the protocol was high. These updated data suggest that the incorporation of AICs is an important, modifiable infection prevention measure. Vancomycin irrigation was also identified as a protective factor but requires further study to better understand its role in preventing shunt infection.
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Affiliation(s)
- Jason Chu
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Hailey Jensen
- 2Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Richard Holubkov
- 2Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Mark D Krieger
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Abhaya V Kulkarni
- 3Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Jay Riva-Cambrin
- 4Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Curtis J Rozzelle
- 5Section of Pediatric Neurosurgery, Division of Neurosurgery, Children's Hospital of Alabama, University of Alabama-Birmingham, Alabama
| | - David D Limbrick
- 6Department of Neurosurgery, St. Louis Children's Hospital, Washington University in St. Louis, Missouri
| | - John C Wellons
- 7Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel R Browd
- 8Department of Neurosurgery, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - William E Whitehead
- 9Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ian F Pollack
- 10Division of Neurosurgery, Children's Hospital of Pittsburgh, Pennsylvania
| | - Tamara D Simon
- 11Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Mandeep S Tamber
- 12Department of Surgery, Division of Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason S Hauptman
- 8Department of Neurosurgery, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan Pindrik
- 13Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Robert P Naftel
- 7Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick J McDonald
- 14Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd C Hankinson
- 15Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric M Jackson
- 16Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Brandon G Rocque
- 5Section of Pediatric Neurosurgery, Division of Neurosurgery, Children's Hospital of Alabama, University of Alabama-Birmingham, Alabama
| | - Ron Reeder
- 2Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - James M Drake
- 3Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - John R W Kestle
- 17Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D. Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist 2022; 15:697-721. [PMID: 35250284 PMCID: PMC8896765 DOI: 10.2147/idr.s326456] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/05/2022] [Indexed: 12/31/2022] Open
Abstract
Ventriculitis or post-neurosurgical meningitis or healthcare-associated ventriculitis and meningitis (VM) is a severe infection that complicates central nervous system operations or is related to the use of neurosurgical devices or drainage catheters. It can further deteriorate patients who have already presented significant neurologic injury and is associated with high morbidity, mortality, and poor functional outcome. VM can be difficult to distinguish from aseptic meningitis, inflammation that follows hemorrhagic strokes and neurosurgical operations. The associated microorganisms can be either skin flora or nosocomial pathogens, most commonly, Gram-negative bacteria. Classical microbiology can fail to isolate the culprit pathogen. Novel cerebrospinal fluid (CSF) biomarkers and molecular microbiology can fill the diagnostic gap and expedite pathogen identification and treatment. The pathogens may demonstrate significant resistant patterns and their antibiotic treatment can be difficult, as many important drug classes, including the beta-lactams and the glycopeptides, hardly penetrate to the CSF, and do not achieve therapeutic levels at the site of the infection. Treatment modifications, such as higher daily dose and prolonged or continuous administration, might increase antibiotic levels in the site of infection and facilitate pathogens clearance. However, in the case of therapeutic failure or infection due to difficult-to-treat bacteria, the direct antibiotic instillation into the CSF, in addition to the intravenous antibiotic delivery, may help in the resolution of infection. However, intraventricular antibiotic therapy may result in aseptic meningitis and seizures, concerning the administration of aminoglycosides, polymyxins, and vancomycin. Meanwhile, bacteria form biofilms on the catheter or the device that should routinely be removed. Novel neurosurgical treatment modalities comprise endoscopic evacuation of debris and irrigation of the ventricles. VM prevention includes perioperative antibiotics, antimicrobial impregnated catheters, and the implementation of standardized protocols, regarding catheter insertion and manipulation.
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Affiliation(s)
- Marios Karvouniaris
- Intensive Care Unit, AHEPA University Hospital, Thessaloniki, Greece
- Correspondence: Marios Karvouniaris, ACHEPA University Hospital, S.Kiriakidi 1, Thessaloniki, 54636, Greece, Tel +302313303645, Fax +302313303096, Email
| | - Alexandros Brotis
- Neurosurgery Department, University Hospital of Larissa, Larissa, Greece
| | | | - Eleni Palli
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Alvi MA, Bhandarkar AR, Daniels DJ, Miller KJ, Ahn ES. Factors associated with early shunt revision within 30 days: analyses from the National Surgical Quality Improvement Program. J Neurosurg Pediatr 2022; 29:21-30. [PMID: 34624850 DOI: 10.3171/2021.7.peds21222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE CSF shunt insertion is the most commonly performed neurosurgical procedure for pediatric patients with hydrocephalus, and complications including infections and catheter obstruction are common. The rate of readmission in the first 30 days after surgery has been used across surgical disciplines to determine healthcare quality. In the current study, the authors sought to assess factors associated with early shunt revision within 30 days using real-world data. METHODS Targeted shunt data set participant user files of the National Surgical Quality Improvement Program (NSQIP) from 2016 to 2019 were queried for patients undergoing a shunt procedure. A multivariable logistic regression model was performed to assess the impact of demographics, etiologies, comorbidities, congenital malformations, and shunt adjuncts on shunt revision within 30 days, as well as shunt revision due to infection within 30 days. RESULTS A total of 3919 primary pediatric shunt insertions were identified in the NSQIP database, with a mean (± SD) patient age of 26.3 ± 51.6 months. There were a total of 285 (7.3%) unplanned shunt revisions within 30 days, with a mean duration of 14.9 ± 8.5 days to first intervention. The most common reason for intervention was mechanical shunt failure (32.6% of revision, 2.4% overall, n = 93), followed by infection (31.2% of all interventions, 2.3% overall, n = 89) and wound disruption or CSF leak (22.1% of all interventions, 1.6% overall, n = 63). Patients younger than 6 months of age had the highest overall unplanned 30-day revision rate (8.5%, 203/2402) as well as the highest 30-day shunt infection rate (3%, 72/2402). Patients who required a revision were also more likely to have a cardiac risk factor (34.7%, n = 99, vs 29.2%, n = 1061; p = 0.048). Multivariable logistic regression revealed that compared to patients 9-18 years old, those aged 2-9 years had significantly lower odds of repeat shunt intervention (p = 0.047), while certain etiologies including congenital hydrocephalus (p = 0.0127), intraventricular hemorrhage (IVH) of prematurity (p = 0.0173), neoplasm (p = 0.0005), infection (p = 0.0004), and syndromic etiology (p = 0.0136), as well as presence of ostomy (p = 0.0095), were associated with higher odds of repeat intervention. For shunt infection, IVH of prematurity was found to be associated with significantly higher odds (p = 0.0427) of shunt infection within 30 days, while use of intraventricular antibiotics was associated with significantly lower odds (p = 0.0085). CONCLUSIONS In this study of outcomes after pediatric shunt placement using a nationally derived cohort, early shunt failure and infection within 30 days were found to remain as considerable risks. The analysis of this national surgical quality registry confirms that, in accordance with other multicenter studies, hydrocephalus etiology, age, and presence of ostomy are important predictors of the need for early shunt revision. IVH of prematurity is associated with early infections while intraventricular antibiotics may be protective. These findings could be used for benchmarking in hospital efforts to improve quality of care for pediatric patients with hydrocephalus.
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Affiliation(s)
| | - Archis R Bhandarkar
- 1Department of Neurologic Surgery, Mayo Clinic; and.,2Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | | | - Kai J Miller
- 1Department of Neurologic Surgery, Mayo Clinic; and
| | - Edward S Ahn
- 1Department of Neurologic Surgery, Mayo Clinic; and
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19
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Otun A, Morales DM, Garcia-Bonilla M, Goldberg S, Castaneyra-Ruiz L, Yan Y, Isaacs AM, Strahle JM, McAllister JP, Limbrick DD. Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity. Fluids Barriers CNS 2021; 18:62. [PMID: 34952604 PMCID: PMC8710025 DOI: 10.1186/s12987-021-00295-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00295-8.
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Affiliation(s)
- Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Seth Goldberg
- Department of Nephrology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | | | - Yan Yan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
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20
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Mansoor N, Solheim O, Fredriksli OA, Gulati S. Shunt complications and revisions in children: A retrospective single institution study. Brain Behav 2021; 11:e2390. [PMID: 34661978 PMCID: PMC8613436 DOI: 10.1002/brb3.2390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/24/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Shunt surgery in children is associated with high revision and complication rates. We investigated revision rates and postoperative complications to specify current challenges associated with pediatric shunt surgery. METHODS All patients aged < 18 years admitted to St. Olavs University Hospital, Norway, from January 2008 through December 2017, who underwent primary shunt insertions, were reviewed. Follow-up ranged from 1 to 10 years. Ventriculoperitoneal, cystoperitoneal, and ventriculoatrial shunts were included. All subsequent shunt revisions and 30-day postoperative complication rates were registered. RESULTS 81 patients underwent 206 surgeries in the study period. 47 patients (58%) required minimum one revision during follow-up. In 14 (29.8%), the first revision was due to the misplacement of hardware. Proximal occlusion was the most common cause of revision (30.4%), followed by misplacement (18.5%) and infection (9.6%). Young age and MMC were associated with revision surgery in a univariable analysis, but were not significant in multivariable analyses. Congenital hydrocephalus was associated with infection (p = .028). In approximately 30% of procedures, complications occurred within 30 days postoperatively, the most common being revision surgery. In approximately 5% of the procedures, medical complications occurred. CONCLUSION Children are prone to high revision and complication rates, and in this study, misplacement of hardware and proximal occlusion were the most common. Complication rates should not be limited to revision rates only, as 30-day complication rates indicate a significant rate of other complications as well. Multi-targeted approaches, perhaps focusing on measures to reduce misplacement, may be key to reducing revision rates.
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Affiliation(s)
- Nadia Mansoor
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddrun A Fredriksli
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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21
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Gerges C, Wijesekera O, Herring E, Adesina A, Wright CH, Woodard J, Stout A, Rothstein B, Selden N, Wright J. Evaluation of Risk of Gastrostomy and Ventriculoperitoneal Shunt Placement in Pediatric Patients: A Systematic Review of the Literature. World Neurosurg 2021; 152:180-188.e1. [PMID: 34033958 DOI: 10.1016/j.wneu.2021.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
A subset of patients with neurologic deficits require ventriculoperitoneal shunt (VPS) placement in addition to gastrostomy tubes (GTs). At present, the literature is inconsistent with respect to the sequence and time period between procedures that yields the lowest risk profile for GT and VPS placement. The purpose of this systematic literature review was to determine if time elapsed between VPS and GT placement was associated with infection (peritoneal and/or CSF). A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. PubMEd/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases were queried. Precise search terminology is available in the body of the manuscript. The initial database query yielded 88 unique articles. After abstract screening, 28 articles were identified and 6 met criteria for inclusion in the final analysis. The included studies were all retrospective analyses and reported data for 217 patients between the years of 1988 and 2016. Across all included studies, the infection rate after VPS and GT placement during the studies' surveillance period was 15.2% (n = 33/217). The cumulative rate of all reported complications in patients with both VPS and GT was 24.0% (n = 52/217). These studies suggest that placement of GT in patients with preexisting VPS does not significantly contribute to increased shunt or intraperitoneal infection. Future studies should determine the optimal time interval between VPS and GT placement and to identify the most appropriate prophylactic antibiotic regimen.
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Affiliation(s)
- Christina Gerges
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Olindi Wijesekera
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eric Herring
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Adeleso Adesina
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jos'lyn Woodard
- Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Amber Stout
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian Rothstein
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Nathan Selden
- Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - James Wright
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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22
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Hale AT, Riva-Cambrin J, Wellons JC, Jackson EM, Kestle JRW, Naftel RP, Hankinson TC, Shannon CN. Machine learning predicts risk of cerebrospinal fluid shunt failure in children: a study from the hydrocephalus clinical research network. Childs Nerv Syst 2021; 37:1485-1494. [PMID: 33515058 DOI: 10.1007/s00381-021-05061-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE While conventional statistical approaches have been used to identify risk factors for cerebrospinal fluid (CSF) shunt failure, these methods may not fully capture the complex contribution of clinical, radiologic, surgical, and shunt-specific variables influencing this outcome. Using prospectively collected data from the Hydrocephalus Clinical Research Network (HCRN) patient registry, we applied machine learning (ML) approaches to create a predictive model of CSF shunt failure. METHODS Pediatric patients (age < 19 years) undergoing first-time CSF shunt placement at six HCRN centers were included. CSF shunt failure was defined as a composite outcome including requirement for shunt revision, endoscopic third ventriculostomy, or shunt infection within 5 years of initial surgery. Performance of conventional statistical and 4 ML models were compared. RESULTS Our cohort consisted of 1036 children undergoing CSF shunt placement, of whom 344 (33.2%) experienced shunt failure. Thirty-eight clinical, radiologic, surgical, and shunt-design variables were included in the ML analyses. Of all ML algorithms tested, the artificial neural network (ANN) had the strongest performance with an area under the receiver operator curve (AUC) of 0.71. The ANN had a specificity of 90% and a sensitivity of 68%, meaning that the ANN can effectively rule-in patients most likely to experience CSF shunt failure (i.e., high specificity) and moderately effective as a tool to rule-out patients at high risk of CSF shunt failure (i.e., moderately sensitive). The ANN was independently validated in 155 patients (prospectively collected, retrospectively analyzed). CONCLUSION These data suggest that the ANN, or future iterations thereof, can provide an evidence-based tool to assist in prognostication and patient-counseling immediately after CSF shunt placement.
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Affiliation(s)
- Andrew T Hale
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 2200 Pierce Ave., Light Hall 514, Nashville, TN, 37232, USA. .,Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA.
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - John C Wellons
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA
| | - Eric M Jackson
- Department of Neurosurgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John R W Kestle
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Robert P Naftel
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA
| | - Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA
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23
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Shibamura-Fujiogi M, Ormsby J, Breibart M, Warf B, Priebe GP, Soriano SG, Sandora TJ, Yuki K. Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study. BMC Anesthesiol 2021; 21:124. [PMID: 33882858 PMCID: PMC8059169 DOI: 10.1186/s12871-021-01342-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Infection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital. Methods We performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI. Results We identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures. Conclusion We identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.
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Affiliation(s)
- Miho Shibamura-Fujiogi
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Anaesthesia, Harvard Medical School, Boston, USA.,Department of Immunology, Harvard Medical School, Boston, USA
| | - Jennifer Ormsby
- Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, USA
| | - Mark Breibart
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benjamin Warf
- Department of Neurosurgery, Boston Children's Hospital, Boston, USA
| | - Gregory P Priebe
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Anaesthesia, Harvard Medical School, Boston, USA.,Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, USA
| | - Sulpicio G Soriano
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Anaesthesia, Harvard Medical School, Boston, USA
| | - Thomas J Sandora
- Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Koichi Yuki
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Anaesthesia, Harvard Medical School, Boston, USA. .,Department of Immunology, Harvard Medical School, Boston, USA.
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24
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Lai GY, Voyer-Nguyen P, Looi T, Drake JM, Hanak BW. Manual Shunt Connector Tool to Aid in No-Touch Technique. Oper Neurosurg (Hagerstown) 2021; 20:183-188. [PMID: 32974661 DOI: 10.1093/ons/opaa284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Given the morbidity and cost associated with cerebrospinal fluid shunt infections, many neurosurgical protocols implement "no-touch" technique to minimize infection. However, current surgical tools are not designed specifically for this task and surgeons often resort to using their hands to connect the shunt catheter to the valve. OBJECTIVE To develop an efficient and effective shunt assembly tool. METHODS Prototypes were designed using computer assisted software and machined in stainless steel. The amount of time and number of attempts it took volunteers to connect a Bacticel shunt catheter to a Delta valve were recorded using the new tool and standard shodded mosquitos. Scanning electron microscopy (SEM) was done on manipulated catheters to assess potential damage. Practicing neurosurgeons provided feedback. RESULTS Nonsurgeon (n = 13) volunteers and neurosurgeons (n = 6) both completed the task faster and with fewer attempts with the new tool (mean 7.18 vs 15.72 s and 2.00 vs 6.36 attempts, P < .0001; mean 2.93 vs 5.96 s and 1.06 vs 2.94 attempts, P < .001, respectively). SEM of 24 manipulated catheters showed no microscopic damage. 100% of neurosurgeons surveyed (n = 10) would adapt the tool in their practice, 90% preferred use of the new tool compared to their existing method, and 100% rated it easier to use compared to existing instruments. CONCLUSION The new tool shortened the time and number of attempts to connect a shunt catheter to a valve. Neurosurgeons preferred the new tool to existing instruments. There was no evidence of catheter damage with the use of this tool.
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Affiliation(s)
- Grace Y Lai
- Department of Neurological Surgery , McGaw Medical Center of Northwestern University, Chicago, Illinois.,Center for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Canada
| | - Pascal Voyer-Nguyen
- Center for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Canada
| | - Thomas Looi
- Center for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Canada
| | - James M Drake
- Center for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Brian W Hanak
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada.,Department of Neurosurgery, Loma Linda University Health, Loma Linda, California
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25
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Serafimova M, Soleman J, Stoessel T, Guzman R, Constantini S, Roth J. Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion. Childs Nerv Syst 2021; 37:115-123. [PMID: 32591874 DOI: 10.1007/s00381-020-04760-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Ventriculo-peritoneal shunts are commonly used for treating hydrocephalus for all age groups. There are 3 main methods for shunt placement into the peritoneum: mini laparotomy, laparoscopically guided, or percutaneously with a trocar. There is limited literature comparing between these techniques in the pediatric population, and specifically-the trocar has not been compared with laparoscopy. The goal of this study is to compare trocar and laparoscopy use, with respect to safety and potential need for future shunt revisions. METHODS Data was retrospectively collected from 2 centers for children (< 18 years old) who underwent a primary insertion of a CSF shunt to the peritoneum, and had no prior abdominal surgery or significant abdominal disease. One center used a trocar, and the other laparoscopic guidance. Demographics, surgical time, and shunt complications were analyzed. Primary endpoint was distal shunt malfunction, either technique-related or non-technique-related. RESULTS Two hundred fifty-seven children (220 trocar, 37 laparoscopy) were included. The groups were similar with regard to age at surgery and etiology of hydrocephalus. Trocar use was associated with a slightly higher, although statistically insignificant, rate of technique-related distal complications (4.1% vs 0, p = 0.37). Following propensity score matching, there was no statistically significant difference in any shunt complication between both groups. Trocar use was associated with shorter surgery, and less surgical personnel. CONCLUSIONS In primary shunt surgery in children, abdominal placement of the catheter using a trocar or laparoscopic guidance is safe, and associated with a low distal malfunction rate, with no statistically significant differences between both techniques.
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Affiliation(s)
- Marga Serafimova
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Jehuda Soleman
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.,Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Tabea Stoessel
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel. .,Tel-Aviv University, Tel-Aviv, Israel.
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26
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Mohamed M, Mediratta S, Chari A, da Costa CS, James G, Dawes W, Aquilina K. Post-haemorrhagic hydrocephalus is associated with poorer surgical and neurodevelopmental sequelae than other causes of infant hydrocephalus. Childs Nerv Syst 2021; 37:3385-3396. [PMID: 34148130 PMCID: PMC8578110 DOI: 10.1007/s00381-021-05226-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This retrospective cohort study aimed to investigate the surgical and neurodevelopmental outcomes (NDO) of infant hydrocephalus. We also sought to determine whether these outcomes are disproportionately poorer in post-haemorrhagic hydrocephalus (PHH) compared to other causes of infant hydrocephalus. METHODS A review of all infants with hydrocephalus who had ventriculoperitoneal (VP) shunts inserted at Great Ormond Street Hospital (GOSH) from 2008 to 2018 was performed. Demographic, surgical, neurodevelopmental, and other clinical data extracted from electronic patient notes were analysed by aetiology. Shunt survival, NDO, cerebral palsy (CP), epilepsy, speech delay, education, behavioural disorders, endocrine dysfunction, and mortality were evaluated. RESULTS A total of 323 infants with median gestational age of 37.0 (23.29-42.14) weeks and birthweight of 2640 g (525-4684 g) were evaluated. PHH was the most common aetiology (31.9%) and was associated with significantly higher 5-year shunt revision rates, revisions beyond a year, and median number of revisions than congenital or "other" hydrocephalus (all p < 0.02). Cox regression demonstrated poorest shunt survival in PHH, related to gestational age at birth and corrected age at shunt insertion. PHH also had the highest rate of severe disabilities, increasing with age to 65.0% at 10 years, as well as the highest CP rate; only genetic hydrocephalus had significantly higher endocrine dysfunction (p = 0.01) and mortality rates (p = 0.04). CONCLUSIONS Infants with PHH have poorer surgical and NDO compared to all other aetiologies, except genetic hydrocephalus. Research into measures of reducing neurodisability following PHH is urgently required. Long-term follow-up is essential to optimise support and outcomes.
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Affiliation(s)
- Malak Mohamed
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK. .,Leeds School of Medicine, University of Leeds, Leeds, UK.
| | - Saniya Mediratta
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | - Aswin Chari
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK ,Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | | | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - William Dawes
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK ,Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - Kristian Aquilina
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK ,Department of Neurosurgery, Great Ormond Street Hospital, London, UK
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27
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A comparison between flow-regulated and adjustable valves used in hydrocephalus during infancy. Childs Nerv Syst 2020; 36:2013-2019. [PMID: 32152667 DOI: 10.1007/s00381-020-04552-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Ventriculoperitoneal shunt insertion during the neonatal period and early infancy is associated with a high rate of shunt failure when compared to the adult population. Furthermore, the function of flow-regulated valves and differential pressure valves may be different in neonatal hydrocephalus. METHODS A retrospective case series of all primary shunt procedures carried out during or immediately following the neonatal period, from August 2011 to February 2018 at Sheffield Children's Hospital. The total sample size was 55. This included 34 patients with adjustable valves (Miethke ProGav) and 21 with flow-regulated valves (Orbis-Sigma); however, only 53 had adequate follow-up. RESULTS The overall 1 year shunt survival was 34% (18/53), and there was no significant difference depending on which shunt valve was implanted. The primary shunt infection rate was 11% (6/53) with S. aureus being the most common causative organism. During the first year of life, clinical signs of shunt overdrainage were seen more frequently in patients with adjustable valves than in those with flow-regulated valves (59% [19/32] versus 24% [5/21], p = 0.02). Furthermore, 2 patients in the adjustable valve group developed sagittal craniosynostosis secondary to shunt overdrainage. CONCLUSION Shunt failure is high when inserted during or immediately following the neonatal period. Overdrainage may be less common in patients with flow-regulated valves. However, if overdrainage is observed, adjusting the setting of a differential pressure valve can effectively treat the overdrainage without the need for invasive shunt revision surgery.
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28
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Wynn JL. Application of metabolomics to neonatal meningitis. Pediatr Res 2020; 88:155-156. [PMID: 32396924 PMCID: PMC7390664 DOI: 10.1038/s41390-020-0954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 11/23/2022]
Affiliation(s)
- James L. Wynn
- Department of Pediatrics, University of Florida, Gainesville, Florida,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
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29
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Pindrik J, Riva-Cambrin J, Kulkarni AV, Alvey JS, Reeder RW, Pollack IF, Wellons JC, Jackson EM, Rozzelle CJ, Whitehead WE, Limbrick DD, Naftel RP, Shannon C, McDonald PJ, Tamber MS, Hankinson TC, Hauptman JS, Simon TD, Krieger MD, Holubkov R, Kestle JRW. Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2020; 26:337-345. [PMID: 32559741 DOI: 10.3171/2020.4.peds19632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have addressed surgical resource utilization-surgical revisions and associated hospital admission days-following shunt insertion or endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) for CSF diversion in hydrocephalus. Study members of the Hydrocephalus Clinical Research Network (HCRN) investigated differences in surgical resource utilization between CSF diversion strategies in hydrocephalus in infants. METHODS Patients up to corrected age 24 months undergoing initial definitive treatment of hydrocephalus were reviewed from the prospectively maintained HCRN Core Data Project (Hydrocephalus Registry). Postoperative courses (at 1, 3, and 5 years) were studied for hydrocephalus-related surgeries (primary outcome) and hospital admission days related to surgical revision (secondary outcome). Data were summarized using descriptive statistics and compared using negative binomial regression, controlling for age, hydrocephalus etiology, and HCRN center. The study population was organized into 3 groups (ETV alone, ETV with CPC, and CSF shunt insertion) during the 1st postoperative year and 2 groups (ETV alone and CSF shunt insertion) during subsequent years due to limited long-term follow-up data. RESULTS Among 1090 patients, the majority underwent CSF shunt insertion (CSF shunt, 83.5%; ETV with CPC, 10.0%; and ETV alone, 6.5%). Patients undergoing ETV with CPC had a higher mean number of revision surgeries (1.2 ± 1.6) than those undergoing ETV alone (0.6 ± 0.8) or CSF shunt insertion (0.7 ± 1.3) over the 1st year after surgery (p = 0.005). At long-term follow-up, patients undergoing ETV alone experienced a nonsignificant lower mean number of revision surgeries (0.7 ± 0.9 at 3 years and 0.8 ± 1.3 at 5 years) than those undergoing CSF shunt insertion (1.1 ± 1.9 at 3 years and 1.4 ± 2.6 at 5 years) and exhibited a lower mean number of hospital admission days related to revision surgery (3.8 ± 10.3 vs 9.9 ± 27.0, p = 0.042). CONCLUSIONS Among initial treatment strategies for hydrocephalus, ETV with CPC yielded a higher surgical revision rate within 1 year after surgery. Patients undergoing ETV alone exhibited a nonsignificant lower mean number of surgical revisions than CSF shunt insertion at 3 and 5 years postoperatively. Additionally, the ETV-alone cohort demonstrated significantly fewer hospital admission days related to surgical management of hydrocephalus within 3 years after surgery. These findings suggest a time-dependent benefit of ETV over CSF shunt insertion regarding surgical resource utilization.
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Affiliation(s)
- Jonathan Pindrik
- 1Division of Pediatric Neurosurgery, Department of Neurological Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jay Riva-Cambrin
- 2Section of Pediatric Neurosurgery, Division of Neurosurgery, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Abhaya V Kulkarni
- 3Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Jessica S Alvey
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Ron W Reeder
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Ian F Pollack
- 5Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John C Wellons
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric M Jackson
- 7Department of Neurosurgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Curtis J Rozzelle
- 8Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama School of Medicine, Birmingham, Alabama
| | - William E Whitehead
- 9Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - David D Limbrick
- 10Division of Pediatric Neurosurgery, Departments of Neurological Surgery and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Missouri
| | - Robert P Naftel
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis Shannon
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick J McDonald
- 11Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mandeep S Tamber
- 11Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Todd C Hankinson
- 12Departments of Neurosurgery and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jason S Hauptman
- 13Division of Pediatric Neurosurgery, Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Tamara D Simon
- 13Division of Pediatric Neurosurgery, Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Mark D Krieger
- 14Department of Surgery, Children's Hospital of Los Angeles, California; and
| | - Richard Holubkov
- 15Hydrocephalus Clinical Research Network Data Coordinating Center, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - John R W Kestle
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Paudel P, Bista P, Pahari DP, Sharma GR. Ventriculoperitoneal Shunt Complication in Pediatric Hydrocephalus: Risk Factor Analysis from a Single Institution in Nepal. Asian J Neurosurg 2020; 15:83-87. [PMID: 32181178 PMCID: PMC7057869 DOI: 10.4103/ajns.ajns_216_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/23/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: Ventriculoperitoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedures. Complications due to shunt failure are associated with high morbidity and mortality. We report an analysis of risk factors for shunt failure in pediatric patients from a single institution in Nepal. Materials and Methods: A retrospective analytical study with prospective data was designed. All children younger than 15 years, with first time VP shunting, at a tertiary government hospital in Kathmandu during 2014-2017 were followed up. Association of independent variables with the primary outcome variable (complication of VP shunt) was analyzed using Chi-square test. Bivariate logistic regression was performed to identify unadjusted odds ratio (OR) with 95% confidence interval (CI). Multivariate logistic regression model was designed to calculate adjusted OR with 95% CI. Results: Of 120 patients, more than half (55.8%) of the patients were male. Mean age was 62.97 months. Maximum duration of follow-up was 30 months. Most common cause of hydrocephalus was congenital aqueductal stenosis (40.8%) followed by tumors (29.2%). Overall shunt complication was found in 26.7% (95% CI 19.0%–35.5%). Shunt infection was seen in 5% while malfunction without infection was found in 21.7%. Bivariate logistic regression showed duration of surgery more than 1 h (OR 2.67, 95% CI 1.11–6.42, P = 0.028) compared to 1 h or less, experienced surgeon (OR 0.37, 95% CI 0.16–0.89, P = 0.026) compared to residents, and emergency surgery (OR 3.97, 95% CI 1.69–9.29, P = 0.001) compared to elective surgery as significant risk factors, while emergency surgery was the only significant variable for shunt failure on multivariate regression analysis (OR 3.3, 95% CI 1.16–9.35, P = 0.025). Conclusion: Longer duration of surgery, less experience of the surgeon, and the priority of the case (emergency) were independent risk factors for shunt complications.
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Affiliation(s)
- Prakash Paudel
- Department of Neurosciences, Mediciti Hospital, Latitpur, Uttar Pradesh, India.,Department of Neurosurgery, Bir Hospital, Kathmandu, Nepal
| | - Prakash Bista
- Department of Neurosurgery, Bir Hospital, Kathmandu, Nepal
| | - Durga Prasad Pahari
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Gopal Raman Sharma
- Department of Neurosciences, Mediciti Hospital, Latitpur, Uttar Pradesh, India.,Department of Neurosurgery, Bir Hospital, Kathmandu, Nepal
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Value of computerized shunt infusion study in assessment of pediatric hydrocephalus shunt function-a two center cross-sectional study. Childs Nerv Syst 2020; 36:59-71. [PMID: 31372736 DOI: 10.1007/s00381-019-04264-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hydrocephalus shunt malfunction can-also in children-occur insidiously without clear symptoms of raised intracranial pressure (ICP) or changes in ventricular size, imposing a diagnostic challenge. Computerized shunt infusion studies enable quantitative shunt function assessment. We report on feasibility and results of this technique in children in a two center cross-sectional study. MATERIAL AND METHODS Shunt infusion study (SIS) is performed with two needles inserted into a pre-chamber for ICP recording and CSF infusion. After baseline ICP recording, constant rate infusion is started until a new ICP plateau (ICPpl) is reached. Dedicated software containing the shunt's resistance characteristics calculates ICP and its amplitude outflow resistance and critical shunt pressure (CSP). Overall, 203 SIS were performed in 166 children. Shunts were defined as functional if ICPpl was <CSP and obstructed if ICPpl was > 5 mmHg above CSP and borderline in between. RESULTS Forty-one shunts (20.2%) were found obstructed, 26 (12.8%) had borderline characteristics, and 136 (67%) were functional. Baseline ICP in obstructed shunts was significantly above shunt operating pressure. CSF outflow resistance (Rout) and ∆ICP plateau were significantly elevated in obstructed shunts, with cut-off thresholds of 8.07 mmHg min/ml and 11.74 mmHg respectively. Subgroup analysis showed smaller ventricles in 69% of revised cases. CONCLUSION SIS is a feasible, reliable, and radiation-free technique for quantitative shunt assessment to rule out or prove shunt malfunction. Dedicated software containing shunt hydrodynamic characteristics is necessary and small children may need short-term sedation. Due to the clinical and inherent economic advantages, SIS should be more frequently used in pediatric neurosurgery.
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Iyer RR, Gorelick N, Carroll K, Blitz AM, Beck S, Garrett CM, Monroe A, Tyler B, Zuckerman ST, Capadona JR, von Recum HA, Luciano MG. Evaluation of an in vivo model for ventricular shunt infection: a pilot study using a novel antimicrobial-loaded polymer. J Neurosurg 2019; 131:587-595. [PMID: 30074457 DOI: 10.3171/2018.1.jns172523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ventricular shunt infection remains an issue leading to high patient morbidity and cost, warranting further investigation. The authors sought to create an animal model of shunt infection that could be used to evaluate possible catheter modifications and innovations. METHODS Three dogs underwent bilateral ventricular catheter implantation and inoculation with methicillin-sensitive Staphylococcus aureus (S. aureus). In 2 experimental animals, the catheters were modified with a polymer containing chemical "pockets" loaded with vancomycin. In 1 control animal, the catheters were polymer coated but without antibiotics. Animals were monitored for 9 to 11 days, after which the shunts were explanted. MRI was performed after shunt implantation and prior to catheter harvest. The catheters were sonicated prior to microbiological culture and also evaluated by electron microscopy. The animals' brains were evaluated for histopathology. RESULTS All animals underwent successful catheter implantation. The animals developed superficial wound infections, but no neurological deficits. Imaging demonstrated ventriculitis and cerebral edema. Harvested catheters from the control animal demonstrated > 104 colony-forming units (CFUs) of S. aureus. In the first experimental animal, one shunt demonstrated > 104 CFUs of S. aureus, but the other demonstrated no growth. In the second experimental animal, one catheter demonstrated no growth, and the other grew trace S. aureus. Brain histopathology revealed acute inflammation and ventriculitis in all animals, which was more severe in the control. CONCLUSIONS The authors evaluated an animal model of ventricular shunting and reliably induced features of shunt infection that could be microbiologically quantified. With this model, investigation of pathophysiological and imaging correlates of infection and potentially beneficial shunt catheter modifications is possible.
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Affiliation(s)
| | | | | | | | - Sarah Beck
- 4Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Caroline M Garrett
- 4Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Sean T Zuckerman
- 5Department of Biomedical Engineering, Case Western Reserve University, Cleveland; and
| | - Jeffrey R Capadona
- 5Department of Biomedical Engineering, Case Western Reserve University, Cleveland; and.,6Advanced Platform Technology Center, Rehabilitation Research and Development, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Horst A von Recum
- 5Department of Biomedical Engineering, Case Western Reserve University, Cleveland; and
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Venable GT, Dave P, Gordon WE, Fraser BD, Wallace DA, Mangham W, Taylor DR, Khan NR, Michael LM, Vaughn BN, Klimo P. Application of the Preventable Shunt Revision Rate to an Adult Population. World Neurosurg 2019; 134:e815-e821. [PMID: 31715417 DOI: 10.1016/j.wneu.2019.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The preventable shunt revision rate (PSRR) was recently introduced in pediatric hydrocephalus as a quality metric for shunt surgery. We evaluated the PSRR in an adult hydrocephalus population. METHODS All ventricular shunt operations (January 1, 2013 to March 31, 2018) performed at a university-based teaching hospital were included. For any index surgery (de novo or revision) resulting in reoperation within 90 days, the index surgery details were collected, and a consensus decision was reached regarding whether the failure had been potentially avoidable. Preventable failure was defined as failure due to infection, malposition, disconnection, migration, or kinking. The 90-day shunt failure rate and PSRR were calculated. Bivariate analyses were performed to evaluate the individual effects of each independent variable on preventable shunt failure. RESULTS A total of 318 shunt operations had been performed in 245 patients. Most patients were women (62%), with a median age of 48.2 years (interquartile range, 31.2-63.2 years). Most had had ventriculoperitoneal shunts placed (86.5%), and just more than one half were new shunts (51.6%). A total of 53 cases (16.7%) in 42 patients experienced shunt failure within 90 days of the index operation. Of these, 27 failures (8.5% of the total cases; 51% of the failures) were considered potentially preventable. The most common reasons were infection (37%; n = 10) and malposition of the proximal and distal catheters (both 25.9%; n = 7). Age was the only statistically significant difference between the 2 groups, with the patients experiencing preventable shunt failure older than those without preventable shunt failure (51.4 vs. 37.1 years; P = 0.017). CONCLUSIONS The 90-day PSRR can be applied to an adult population and serve as a quality metric.
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Affiliation(s)
- Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - William E Gordon
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brittany D Fraser
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David A Wallace
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - William Mangham
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Douglas R Taylor
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Clinic, Memphis, Tennessee, USA
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Clinic, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
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Lu L, Chen H, Weng S, Xu Y. Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2019; 129:334-340. [PMID: 31136836 DOI: 10.1016/j.wneu.2019.04.255] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are 2 surgical methods used for the treatment of obstructive hydrocephalus. However, the efficacy and safety of these 2 procedures are unknown. Therefore we conducted a meta-analysis to compare the safety and efficiency of ETV and VPS in patients with obstructive hydrocephalus. METHODS In January 2019, a comprehensive search strategy of 3 electronic databases was initiated. A systematic search from database inception to December 30, 2018, on clinical outcome, safety, and efficiency of ETV and VPS in the treatment of obstructive hydrocephalus was conducted. The following electronic databases were searched: PubMed, Embase, and Cochrane Library for related randomized controlled trials (RCTs). Main outcomes included postoperative hematoma, postoperative infection, postoperative cerebrospinal fluid leakage, blockage rate, and mortality. RESULTS Of the 546 studies identified, 4 RCTs involving 250 patients met our inclusion criteria. The pooled results show that ETV was associated with lower incidence of postoperative infection (risk ratio [RR] 0.09, 95% confidence interval [CI]: 0.02-0.32, P = 0.0002); postoperative hematoma (RR 0.26, 95% CI: 0.08-0.88, P = 0.03); and blockage rate (RR 0.28, 95% CI: 0.13-0.60, P = 0.001) compared with VPS. Compared with VPS, ETV had no significant effect on incidence rate of postoperative cerebrospinal fluid leakage (RR 2.00, 95% CI: 0.30-13.16, P = 0.47) and mortality rates (RR 0.19, 95% CI: 0.03-1.09, P = 0.06), but there have been no deaths in patients treated with ETV. CONCLUSIONS On the basis of the meta-analysis of RCTs evaluating ETV and VPS, the incidence of complications and mortality was higher with the VPS procedure, and therefore greater benefits can be achieved using ETV.
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Affiliation(s)
- Liang Lu
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China
| | - Hongwu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China
| | - Shaotao Weng
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China
| | - Yimin Xu
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China.
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Zervos T, Walters BC. Diagnosis of Ventricular Shunt Infection in Children: A Systematic Review. World Neurosurg 2019; 129:34-44. [DOI: 10.1016/j.wneu.2019.05.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Atchley TJ, Laskay NMB, Sherrod BA, Rahman AKMF, Walker HC, Guthrie BL. Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement. J Neurosurg 2019; 133:403-410. [PMID: 31174189 DOI: 10.3171/2019.3.jns183023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders. METHODS The authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement. RESULTS In the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24-129 days) and 149 days (IQR 112-285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9-156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1-8.6, p = 0.03). CONCLUSIONS IPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.
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Affiliation(s)
| | | | | | | | - Harrison C Walker
- 2Neurology
- 4Biomedical Engineering, University of Alabama at Birmingham, Alabama
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Riva-Cambrin J, Kestle JRW, Rozzelle CJ, Naftel RP, Alvey JS, Reeder RW, Holubkov R, Browd SR, Cochrane DD, Limbrick DD, Shannon CN, Simon TD, Tamber MS, Wellons JC, Whitehead WE, Kulkarni AV. Predictors of success for combined endoscopic third ventriculostomy and choroid plexus cauterization in a North American setting: a Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr 2019; 24:128-138. [PMID: 31151098 DOI: 10.3171/2019.3.peds18532] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV+CPC) has been adopted by many pediatric neurosurgeons as an alternative to placing shunts in infants with hydrocephalus. However, reported success rates have been highly variable, which may be secondary to patient selection, operative technique, and/or surgeon training. The objective of this prospective multicenter cohort study was to identify independent patient selection, operative technique, or surgical training predictors of ETV+CPC success in infants. METHODS This was a prospective cohort study nested within the Hydrocephalus Clinical Research Network's (HCRN) Core Data Project (registry). All infants under the age of 2 years who underwent a first ETV+CPC between June 2006 and March 2015 from 8 HCRN centers were included. Each patient had a minimum of 6 months of follow-up unless censored by an ETV+CPC failure. Patient and operative risk factors of failure were examined, as well as formal ETV+CPC training, which was defined as traveling to and working with the experienced surgeons at CURE Children's Hospital of Uganda. ETV+CPC failure was defined as the need for repeat ETV, shunting, or death. RESULTS The study contained 191 patients with a primary ETV+CPC conducted by 17 pediatric neurosurgeons within the HCRN. Infants under 6 months corrected age at the time of ETV+CPC represented 79% of the cohort. Myelomeningocele (26%), intraventricular hemorrhage associated with prematurity (24%), and aqueductal stenosis (17%) were the most common etiologies. A total of 115 (60%) of the ETV+CPCs were conducted by surgeons after formal training. Overall, ETV+CPC was successful in 48%, 46%, and 45% of infants at 6 months, 1 year, and 18 months, respectively. Young age (< 1 month) (adjusted hazard ratio [aHR] 1.9, 95% CI 1.0-3.6) and an etiology of post-intraventricular hemorrhage secondary to prematurity (aHR 2.0, 95% CI 1.1-3.6) were the only two independent predictors of ETV+CPC failure. Specific subgroups of ages within etiology categories were identified as having higher ETV+CPC success rates. Although training led to more frequent use of the flexible scope (p < 0.001) and higher rates of complete (> 90%) CPC (p < 0.001), training itself was not independently associated (aHR 1.1, 95% CI 0.7-1.8; p = 0.63) with ETV+CPC success. CONCLUSIONS This is the largest prospective multicenter North American study to date examining ETV+CPC. Formal ETV+CPC training was not found to be associated with improved procedure outcomes. Specific subgroups of ages within specific hydrocephalus etiologies were identified that may preferentially benefit from ETV+CPC.
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Affiliation(s)
- Jay Riva-Cambrin
- 1Alberta Children's Hospital, University of Calgary, Alberta, Canada
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Test MR, Whitlock KB, Langley M, Riva-Cambrin J, Kestle JRW, Simon TD. Relationship of causative organism and time to infection among children with cerebrospinal fluid shunt infection. J Neurosurg Pediatr 2019; 24:22-28. [PMID: 31051463 PMCID: PMC6928433 DOI: 10.3171/2019.2.peds18638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infection is a common complication of cerebrospinal fluid (CSF) shunts, occurring in 6%-20% of children. Although studies are limited, Staphylococcus aureus is thought to cause more rapid and aggressive infection than coagulase-negative Staphylococcus (CONS) or gram-negative organisms. The authors' objective was to evaluate the relationship between the causative organisms of CSF shunt infection and the timing of infection. METHODS The authors performed a retrospective cohort study of children who underwent CSF shunt placement at a tertiary care children's hospital over a 9-year period and subsequently developed a CSF shunt infection. The primary predictor variable was the causative organism recovered from CSF culture, characterized as S. aureus, CONS, or gram-negative organisms. The primary outcome was time to infection, defined as the number of days from most recent shunt intervention to the diagnosis of the infection. The association between causative organism and time to infection was visualized using Kaplan-Meier curves, and statistical comparisons were made using nonparametric Kruskal-Wallis tests. RESULTS Among 103 children in whom a CSF shunt infection developed, the causative organism was CONS in 57 (55%), S. aureus in 19 (18%), and gram-negative organisms in 9 (9%). The median time to infection did not differ (p = 0.81) for infections caused by CONS (20 days, IQR 11-40), S. aureus (26 days, IQR 12-95), and gram-negative organisms (23 days, IQR 17-34). CONCLUSIONS No significant difference in time to infection based on the causative organism was observed among children with a CSF shunt infection.
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Affiliation(s)
- Matthew R. Test
- Department of Pediatrics, University of Washington/ Seattle Children’s Hospital, Seattle, Washington, United States
| | - Kathryn B. Whitlock
- Seattle Children’s Hospital Research Institute, Seattle, Washington, United States
| | - Marcie Langley
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah/ Primary Children’s Hospital (PCH), Salt Lake City, Utah, United States
| | - Jay Riva-Cambrin
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - John RW Kestle
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah/ Primary Children’s Hospital (PCH), Salt Lake City, Utah, United States
| | - Tamara D. Simon
- Department of Pediatrics, University of Washington/ Seattle Children’s Hospital, Seattle, Washington, United States.,Seattle Children’s Hospital Research Institute, Seattle, Washington, United States
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Simon TD, Schaffzin JK, Stevenson CB, Willebrand K, Parsek M, Hoffman LR. Cerebrospinal Fluid Shunt Infection: Emerging Paradigms in Pathogenesis that Affect Prevention and Treatment. J Pediatr 2019; 206:13-19. [PMID: 30528757 PMCID: PMC6389391 DOI: 10.1016/j.jpeds.2018.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Tamara D. Simon
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington, United States,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Charles B. Stevenson
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Kathryn Willebrand
- Department of Microbiology, University of Washington, Seattle, Washington, United States
| | - Matthew Parsek
- Department of Microbiology, University of Washington, Seattle, Washington, United States
| | - Lucas R. Hoffman
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington, United States,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States,Department of Microbiology, University of Washington, Seattle, Washington, United States,Center for Infection and Prematurity Research, Seattle Children’s Research Institute, Seattle, Washington, United States
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Okamura Y, Maruyama K, Fukuda S, Horikawa H, Sasaki N, Noguchi A, Nagane M, Shiokawa Y. Detailed standardized protocol to prevent cerebrospinal fluid shunt infection. J Neurosurg 2019; 132:755-759. [PMID: 30771771 DOI: 10.3171/2018.10.jns181432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While cerebrospinal fluid (CSF) shunt surgery plays an essential role in the treatment of hydrocephalus, postoperative infection due to the implantation of foreign materials is still one of the most common and potentially serious complications of this procedure. Because no previously reported protocol has been proven to prevent postoperative infection after CSF shunt surgeries in adults, the authors investigated the effectiveness of a protocol introduced in their institution. METHODS A detailed standardized surgical protocol to prevent infection in patients undergoing CSF shunt surgeries was introduced in the authors' institution in December 2011. The protocol included a series of detailed rules regarding the surgical procedure, the surgical environment to minimize contamination from air, double gloving, local injection of antibiotics, and postoperative management. The rate of CSF shunt infection during the 3 years after surgery before and after implementation of the protocol was compared in patients undergoing their first CSF shunt surgeries. The inclusion periods were from January 2006 to November 2011 for the preprotocol group and from December 2011 to December 2014 for the postprotocol group. RESULTS The study included 124 preprotocol patients and 52 postprotocol patients. The mean patient age was 59 years in both groups, ranging from 40 days to 88 years. Comparison of patient background factors, including known risk factors for surgical site infections, showed no significant difference between the patient groups before and after implementation of the protocol. While 9 patients (7.3%) developed shunt infections before protocol implementation, no shunt infections (0%) were observed in patients who underwent surgery after protocol implementation. The difference was statistically significant (p = 0.047). CONCLUSIONS The authors' detailed protocol for CSF shunt surgeries was effective in preventing postoperative infection regardless of patient age.
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Kestle JRW, Riva-Cambrin J. Prospective multicenter studies in pediatric hydrocephalus. J Neurosurg Pediatr 2019; 23:135-141. [PMID: 30717034 DOI: 10.3171/2018.10.peds18328] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 11/06/2022]
Abstract
Prospective multicenter clinical research studies in pediatric hydrocephalus are relatively rare. They cover a broad spectrum of hydrocephalus topics, including management of intraventricular hemorrhage in premature infants, shunt techniques and equipment, shunt outcomes, endoscopic treatment of hydrocephalus, and prevention and treatment of infection. The research methodologies include randomized trials, cohort studies, and registry-based studies. This review describes prospective multicenter studies in pediatric hydrocephalus since 1990. Many studies have included all forms of hydrocephalus and used device or procedure failure as the primary outcome. Although such studies have yielded useful findings, they might miss important treatment effects in specific subgroups. As multicenter study networks grow, larger patient numbers will allow studies with more focused entry criteria based on known and evolving prognostic factors. In addition, increased use of patient-centered outcomes such as neurodevelopmental assessment and quality of life should be measured and emphasized in study results. Well-planned multicenter clinical studies can significantly affect the care of children with hydrocephalus and will continue to have an important role in improving care for these children and their families.
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Affiliation(s)
- John R W Kestle
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah; and
| | - Jay Riva-Cambrin
- 2Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
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CSF inflammatory markers differ in gram-positive versus gram-negative shunt infections. J Neuroinflammation 2019; 16:7. [PMID: 30626412 PMCID: PMC6325818 DOI: 10.1186/s12974-019-1395-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/02/2019] [Indexed: 12/28/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) shunt placement is frequently complicated by bacterial infection. Shunt infection diagnosis relies on bacterial culture of CSF which can often produce false-negative results. Negative cultures present a conundrum for physicians as they are left to rely on other CSF indices, which can be unremarkable. New methods are needed to swiftly and accurately diagnose shunt infections. CSF chemokines and cytokines may prove useful as diagnostic biomarkers. The objective of this study was to evaluate the potential of systemic and CSF biomarkers for identification of CSF shunt infection. Methods We conducted a retrospective chart review of children with culture-confirmed CSF shunt infection at Children’s Hospital and Medical Center from July 2013 to December 2015. CSF cytokine analysis was performed for those patients with CSF in frozen storage from the same sample that was used for diagnostic culture. Results A total of 12 infections were included in this study. Patients with shunt infection had a median C-reactive protein (CRP) of 18.25 mg/dL. Median peripheral white blood cell count was 15.53 × 103 cells/mL. Those with shunt infection had a median CSF WBC of 332 cells/mL, median CSF protein level of 406 mg/dL, and median CSF glucose of 35.5 mg/dL. An interesting trend was observed with gram-positive infections having higher levels of the anti-inflammatory cytokine interleukin (IL)-10 as well as IL-17A and vascular endothelial growth factor (VEGF) compared to gram-negative infections, although these differences did not reach statistical significance. Conversely, gram-negative infections displayed higher levels of the pro-inflammatory cytokines IL-1β, fractalkine (CX3CL1), chemokine ligand 2 (CCL2), and chemokine ligand 3 (CCL3), although again these were not significantly different. CSF from gram-positive and gram-negative shunt infections had similar levels of interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α), IL-6, and IL-8. Conclusions This pilot study is the first to characterize the CSF cytokine profile in patients with CSF shunt infection and supports the distinction of chemokine and cytokine profiles between gram-negative and gram-positive infections. Additionally, it demonstrates the potential of CSF chemokines and cytokines as biomarkers for the diagnosis of shunt infection.
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Omrani O, O'Connor J, Hartley J, James G. Effect of introduction of a standardised peri-operative protocol on CSF shunt infection rate: a single-centre cohort study of 809 procedures. Childs Nerv Syst 2018; 34:2407-2414. [PMID: 30132097 PMCID: PMC6224013 DOI: 10.1007/s00381-018-3953-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/15/2018] [Indexed: 10/30/2022]
Abstract
PURPOSE Shunt infection is a major problem in paediatric neurosurgery. Our institution introduced a mandatory shunt protocol with the aim of reducing infection rate. METHODS A retrospective cohort study including consecutive patients undergoing permanent shunt operations (primary insertion and revision) across two study periods: 3 years immediately prior (2009-2012) and 3 years immediately after (2012-2015) protocol introduction. Absolute and relative risk reductions (ARR/RRR) and Chi-square statistical analysis was used alongside logistic regression, where any single factor with p ≤ 0.20 included in the multivariate model, producing an odds ratio (OR). RESULTS Eight hundred nine operations in 504 children were identified (442 pre-protocol, 367 post). Overall infection rate decreased from 5.43% (24/442) pre-protocol to 3.27% (12/367) post-protocol (ARR = 2.16%, RRR = 39.8%, NNT = 46.3, p = 0.138), which did not reach statistical significance. For primary shunt insertions, infection rate reduced from 3.63 to 2.55% (ARR = 1.08%, RRR = 29.8%, NNT = 92.6, p = 0.565), whilst for revisions, it reduced from 6.83 to 3.81% (ARR = 3.02%, RRR 44.2%, NNT = 33.1, p = 0.156). Multivariate logistic regression showed that surgeon experience was a statistically significant predictor of infection, whilst responsible pathogens and latency were similar across the pre- and post-protocol groups. CONCLUSION The protocol reduced overall infection rate in primary and revision shunt operations and we recommend paediatric units consider introducing a similar protocol for these procedures.
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Affiliation(s)
- Osama Omrani
- Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Jody O'Connor
- Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - John Hartley
- Department of Microbiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
- Great Ormond Street Institute of Child Health, University College London, London, UK.
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Erps A, Roth J, Constantini S, Lerner-Geva L, Grisaru-Soen G. Risk factors and epidemiology of pediatric ventriculoperitoneal shunt infection. Pediatr Int 2018; 60:1056-1061. [PMID: 30290047 DOI: 10.1111/ped.13709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/03/2018] [Accepted: 10/01/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to identify independent risk factors for cerebrospinal fluid shunt infection. METHODS The medical records of all patients aged 0-18 years who underwent shunt-related surgery for the treatment of hydrocephalus at the present institution between January 1996 and December 2015 were reviewed. For each case, two randomly selected controls with no shunt infection, matched for year of surgery, were chosen. Demographic clinical and microbiological data were abstracted. RESULTS A total of 1,570 shunt-related procedures met the inclusion criteria, yielding 68 infections (in 63 patients). The control group consisted of 132 infection-free patients. The average annual infection rate was 4.2% cases per year. The median time between shunt procedures to infection was 19 days (range, 1-2,181). On multivariate analysis, risk factors associated with increased risk for developing an infection included a history of two or more previous revisions (OR, 4.8; 95%CI: 1.5-15.9); and age <5 years (OR, 4.5; 95%CI 1.5-13.4). A neoplastic etiology for hydrocephalus was found to be a protective factor for shunt infection (P = 0.001). CONCLUSIONS A history of shunt revision was the most significant risk factor in the development of subsequent shunt infection. Age >5 years was a protective factor. Future efforts should focus on modalities to optimize revision procedures and reduce the risk of subsequent infection.
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Affiliation(s)
- Amir Erps
- Pediatric Infectious Disease Unit, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Lerner-Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research (Ltd), Tel Hashomer, Israel
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Al-Holou WN, Wilson TJ, Ali ZS, Brennan RP, Bridges KJ, Guivatchian T, Habboub G, Krishnaney AA, Lanzino G, Snyder KA, Flanders TM, Than KD, Pandey AS. Gastrostomy tube placement increases the risk of ventriculoperitoneal shunt infection: a multiinstitutional study. J Neurosurg 2018; 131:1062-1067. [PMID: 30497165 DOI: 10.3171/2018.5.jns18506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gastrostomy tube placement can temporarily seed the peritoneal cavity with bacteria and thus theoretically increases the risk of shunt infection when the two procedures are performed contemporaneously. The authors hypothesized that gastrostomy tube placement would not increase the risk of ventriculoperitoneal shunt infection. The object of this study was to test this hypothesis by utilizing a large patient cohort combined from multiple institutions. METHODS A retrospective study of all adult patients admitted to five institutions with a diagnosis of aneurysmal subarachnoid hemorrhage between January 2005 and January 2015 was performed. The primary outcome of interest was ventriculoperitoneal shunt infection. Variables, including gastrostomy tube placement, were tested for their association with this outcome. Standard statistical methods were utilized. RESULTS The overall cohort consisted of 432 patients, 47% of whom had undergone placement of a gastrostomy tube. The overall shunt infection rate was 9%. The only variable that predicted shunt infection was gastrostomy tube placement (p = 0.03, OR 2.09, 95% CI 1.07-4.08), which remained significant in the multivariate analysis (p = 0.04, OR 2.03, 95% CI 1.04-3.97). The greatest proportion of shunts that became infected had been placed more than 2 weeks (25%) and 1-2 weeks (18%) prior to gastrostomy tube placement, but the temporal relationship between shunt and gastrostomy was not a significant predictor of shunt infection. CONCLUSIONS Gastrostomy tube placement significantly increases the risk of ventriculoperitoneal shunt infection.
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Affiliation(s)
- Wajd N Al-Holou
- 1Department of Neurosurgery, Wayne State University, Detroit, Michigan
| | - Thomas J Wilson
- 2Department of Neurosurgery, Stanford University, Stanford, California
| | - Zarina S Ali
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan P Brennan
- 4Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Kelly J Bridges
- 5Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Tannaz Guivatchian
- 6Department of Internal Medicine, Division of Gastroenterology and Hepatology, and
| | - Ghaith Habboub
- 4Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Tracy M Flanders
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Khoi D Than
- 5Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Aditya S Pandey
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
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Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study. Childs Nerv Syst 2018; 34:2203-2213. [PMID: 29987373 PMCID: PMC6326904 DOI: 10.1007/s00381-018-3897-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/29/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The goal of this longitudinal, population-level study was to examine factors affecting mortality in preterm infants with intraventricular hemorrhage (IVH). METHODS The study examined patients who were born at 36 weeks estimated gestational age (EGA) or less with a diagnosis of IVH between the years 2005 and 2014 using data from the New York and Nebraska State Inpatient Databases. Potential predictors for mortality were investigated with multivariable survival analysis. RESULTS The cohort included 7437 preterm infants with IVH. All-cause inpatient mortality occurred in 746 (10.0%). The majority of deaths were in infants born at less than 25 weeks EGA (378 or 50.7%) and with birthweight less than 750 g (459 or 61.5%). Mortality was highest for children with grade IV IVH (306/848 or 36.1%), followed by grades III (203/955 or 21.3%), II (103/1328 or 7.8%), and I (134/4306 or 3.1%). Hydrocephalus was diagnosed within 6 months in 627 (8.4%) patients, with cerebrospinal fluid shunts required in 237 (3.2%). Shunts were eventually revised in 122 (51.5% of shunts), and 43 (18.1%) had infections. Multivariable Cox survival analyses found male sex (HR 1.3 [95% CI 1.1-1.5]), Asian race (HR 1.5 [1.1-2.2]), lower EGA (HR 9.9 [6.3-15.5] for < 25 weeks), higher IVH grade (HR 6.1 [4.9-7.6] for grade IV), gastrostomy (HR 4.0 [2.0-7.7]), tracheostomy (HR 3.5 [1.7-7.1]), and shunt infection (HR 3.2 [1.0-9.9]) to be independently associated with increased mortality risk. CONCLUSIONS This database is the first of its kind assembled for population-based investigations of long-term neurosurgical outcomes in preterm infants with IVH.
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Kanangi SMR, Balasubramaniam C. Shunt infections: a review and analysis of a personal series. Childs Nerv Syst 2018; 34:1915-1924. [PMID: 29978253 DOI: 10.1007/s00381-018-3890-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND PURPOSE CSF diversion shunts are notoriously prone to complications. The most difficult to manage among them is shunt infection, which warrants a prolonged hospital stay. The aim of this paper is to review the pattern of infections, the pathology, and management of shunt infections with special reference to a tertiary pediatric center in a developing country. MATERIALS AND METHODS This is a review of shunt infections in general and a retrospective study of all cases operated in the hospital from 2000 to 2015. RESULTS The authors analyze the data and try to discern patterns, which may enable newer interventions to treat as well as decrease the burden of shunt infections in the future. CONCLUSION It is difficult to determine the true incidence of shunt infections as there is no definition of what constitutes a shunt infection. There are no standardized international guidelines as to how to deal with an infected shunt. Though the ability to treat shunt infection has improved and the incidence of shunt infection has decreased over time, there is still no consensus on the best way to manage it. The prevention is predominantly based on common sense and has helped but a more scientific algorithm is the need of the hour.
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Affiliation(s)
- Santosh Mohan Rao Kanangi
- Department of Pediatric Neurosurgery, Kanchi Kamakoti CHILDS Trust Hospital, 12 A Nageswara Road Nungambakkam, Chennai 34, 600034, India
| | - Chidambaram Balasubramaniam
- Department of Pediatric Neurosurgery, Kanchi Kamakoti CHILDS Trust Hospital, 12 A Nageswara Road Nungambakkam, Chennai 34, 600034, India.
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Latyshev YA, Kravchuk AD, Likhterman LB, Zakharova NE, Zaytsev OS, Gavrilov AG, Okhlopkov VA, Potapov AA. [Modern diagnostics and treatment of posttraumatic hydrocephalus]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:81-87. [PMID: 29927429 DOI: 10.17116/neiro201882381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the frequent consequences of severe traumatic brain injury is posttraumatic hydrocephalus that not only hampers the processes of consciousness recovery, rehabilitation, and social adaptation of patients but also is the cause of disability. Pathological processes underlying the clinical picture of posttraumatic hydrocephalus and the relationship between CSF circulation disorders and structural changes in the brain substance have not been adequately studied. Of particular importance are patients in the chronic vegetative or minimally conscious state, recovery from which is blocked by posttraumatic hydrocephalus. The question of reversibility of impaired consciousness depending on the disease duration has remained open. High risks of purulent-inflammatory complications of shunting surgery are especially important in patients with chronic infection foci (tracheostomy, gastrostomy, epicystostomy, prolonged bladder catheterization, pressure ulcers, etc.), but their actual effect on the shunting outcomes has not been revealed. Posttraumatic hydrocephalus remains a topical neurosurgical problem requiring clarification of its diagnostic criteria, differentiation from atrophy-related ventriculomegaly, and comprehensive development of pathogenetic and therapeutic aspects.
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Affiliation(s)
- Ya A Latyshev
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A D Kravchuk
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - L B Likhterman
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - N E Zakharova
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - O S Zaytsev
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A G Gavrilov
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - V A Okhlopkov
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Potapov
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
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Qin B, Chen G, Chen J. Shunt infection in a single institute: a retrospective study. Chin Neurosurg J 2018; 4:8. [PMID: 32922869 PMCID: PMC7398261 DOI: 10.1186/s41016-018-0115-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background Shunt infection (SI) is a dreaded and major complication in the management of hydrocephalus after cerebral fluid shunts. We reviewed retrospectively shunted for hydrocephalus during the last 2 years to evaluate the incidence of SI, including the risk factors and types of infection. Methods Patients who had undergone a shunt operation from January 2013 to December 2014 in our hospital were observed, study clinical data and a 6-24 months follow-up. Patients with infection complications were found and investigated. Results Among 343 cases of shunt surgery performed in our hospital, 6–24 months follow-up was done. 13 patients (10 men and 3 women) were found shunt infections, 11 (3.7%) were post-operation of ventriculo-peritoneal shunt and 2 (4.2%) of lumbo-peritoneal shunt.92.3% cases of shunt infections were present within 2 months after shunt surgery, gram positive cocci accounted for 90% of the bacteria. After different surgery and antibiotic treatment, 8 patients became better and 5 worse. Conclusions The data in our single institution shows no significant differences between sex and shunt surgery. Infections more likely to present within the first 2 months after shunt placement, and gram-positive cocci account for a great proportion in detected bacteria.
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Affiliation(s)
- Bing Qin
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Gao Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jingyin Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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